Vaginal Bleeding and Intralabial (Introital) Masses Urethral Prolapse |
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Incidence | |
A prolapse of the urethra is probably a relatively frequent cause of apparent vaginal bleeding during childhood and occurs in 50 percent in children, and thereafter, mainly beyond menopause. Toddlers, schoolchildren of up to 10 years of age, and girls of African ethnicity are particularly involved. | |
Clinical significance | |
1. A urethral prolapse belongs to the relatively frequent causes of an abnormal vaginal bleeding in children. | |
Etiology | |
Unknown. Increased intraabdominal pressure due to coughing, crying or squeezing are discussed as causes of prolapse, e. g. in constipation. | |
Pathology, anatomical types | |
There is a prolapse of the mucous membrane of the distal urethra which is strangulated at the level of its introitus. | |
Pathophysiology | |
Following strangulation, a venous backflow occurs, followed by ischemia and infarction of the prolapsed mucosa. | |
Clinical presentation (history, findings, clinical skills) | Illustrations |
History: The leading signs are blood-stained spots on the napkin or panties, or an observed vaginal bleeding and/or an intralabial mass. The former sign most frequently worries the parents. Clinical findings and skills: The inspection of the vulva is performed by pulling the labia majora to the side and backwards. There is an annular mass 1 to 2 centimeters in diameter in front of the introitus with dark-red color in an advanced stage, painful and bleeding on touching. In case of gross swelling it may be impossible to see the central dimple corresponding to the meatus. The diagnosis may be confirmed by a catheterism of the bladder via the central dimple. | show details |
Natural history | |
See pathophysiology. | |
Differential diagnosis | Illustrations |
In contrast to the supposed vaginal bleeding, an intralabial mass is often not recognized by the mother. | show details |
Work-up examinations | |
Depending on the history and local findings a rectal and a rectoabdominal palpation must be performed. The same applies to the additional examinations which include blood and urine analysis, vaginal specimen for cultures, abdominal ultrasound, pelvic x-ray, cystocolposcopy, and biopsy under general anesthesia. | |
Therapy | |
Most children who are referred with a urethral prolapse need surgery. It includes a resection of the prolapsed mucous membrane and a suture of the edges, and is performed under general anesthesia. In early diagnosis non-operative management with baths and treatment of cough or constipation may be performed. | |
Prognosis | |
Permanent cure in children.
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